Dental exclusions - know full details of your clinical history!

[Collywobbles]

My child's pony has been having routine annual dental checks and rasping by the vet when his vaccinations were due. Vet said he had good teeth and didn't mention any problems to me except the odd sharp point. Fast forward to this summer when vet identified a broken tooth that needed extracting due to infection. I was surprised (as no concerns had been raised before) and asked whether infection just a year after the previous check was normal and she said that yes, the timescale was possible. She asked me to check with insurer (SEIB) whether the pony was covered for dental work. They procrastinated with their answer but didn't hesitate to put an immediate exclusion on 'teeth and gums' for the next renewal.

As the equine dentist only visits the vet periodically, I had to go ahead with the extraction before hearing back from SEIB. Now they are refusing to pay as on the pony's clinical history (which the vets didn't share with me until the insurers asked for it), there is a reference to 'sharp points' and 'caries' which they said I should have told them about. Consequently they've put a retrospective exclusion on teeth and gums dating to 2015! The vet never mentioned the caries and as I always understood the point of routine rasping to be to get rid of 'sharp points' (don't most equines have these at some point?) I just mentioned that the pony had had his annual 'routine rasping' at renewal.

I've written back to SEIB explaining this but they don't want to know. Really appalling customer service too. So based on my experience, I'm wondering how many others might not be aware that their insurance could refuse to pay for dental work on the basis of observations recorded in the clinical history. Sharp points on teeth are very common and I think caries are too, so I was wondering what proportion of horse owners would actually be excluded from dental treatment if these are mentioned on the clinical history but not raised as a problem by the vet during routine rasping?

If anyone else has similar experiences - or advice - I'd be really grateful to hear it.

 

[Pinkvboots]

I would think the sharp points and the other problem has no bearing on the broken tooth I would ask the vet to do you a letter explaining that neither are connected in any way and see what happens.

 

[Shay]

Worth a challenge certainly - but the noted presence of caries might have had a bearing on the fact that the broken tooth became infected?

 

[Collywobbles]

Thanks Shay and Pinkvboots. I'm pretty sure the caries weren't connected with the broken tooth either so the vet is going to write to SEIB to provide more context on the clinical history. Let's see....

I wouldn't mind if I'd ever made a claim before but it seemed a bit rich to add a retrospectively dated exclusion on the basis of 'sharp points' that were reported during renewal (why else is 'routine rasping done?) and were not connected with what the pony ultimately needed treatment for.

 

[BBP]

Yep mine had a mouth ulcer noted on one routine vet visit to do teeth, minor, no big deal. This was disclosed to vet when I claimed for bone scan for sacroiliac injury and they came back and excluded all oral disorders. They also excluded all 4 legs as 2 of them had been seen by a vet for minor issues, liver (which was fair enough) and spine and back. I cancelled my insurance (I was a little hasty as he was treated for ulcers later that year which was about the only part of him that was still covered!)

 

[ITPersonnage]

Haha KatP I sympathise but I do think sometimes it's easy to think all bits are excluded but then things do happen - mine was excluded skin complaints, front feet, hind legs, back then she bust her stifle (with help...) and the bone scan & treatment was claimable! Thank the lord ! You just have to be lucky if you choose to cancel.

 

[sarahandwilby]

Worth a challenge certainly - but the noted presence of caries might have had a bearing on the fact that the broken tooth became infected?

Caries would normally result in an exclusion for fractured teeth, given that caries can often lead to a fracture.

It could be worth pointing out to you insurance company that if you had used an EDT instead of your veterinary practice, then any dental notes wouldn't be on the veterinary history, and surely having your ponies teeth regularly checked should stand you in good stead for claiming for dental work, as you have tried to do preventative healthcare correctly? Might get them to change their tune slightly.

(Having just seen a 20 year old for it's first dental with 3 fractured molars, sinusitis, horrific overgrowths etc... Yet that would be covered on insurance... I don't see how that's quite fair!)

 

[asmp]

Both our horses have had teeth out. The older one I had only owned for about 6 months when the EDT noticed it on a routine visit. The insurance company at first refused to pay for its extraction as said the horse could have had it when I bought him. I was not very well off at that time and the vet wrote a letter to the insurance company saying it needed to be done and in the end the insurance company paid for half (the extraction cost £1500).

The second horse had his front tooth fractured about 18 months ago. It seemed OK but on a recent EDT visit it was noticed that he had an infection in the gum meaning the tooth needed to come out. An exclusion had been put on the tooth so my daughter had to pay for the treatment. This was a much quicker op as it was a front tooth and cost under £600, including follow up check up.

This probably hasn't helped your case but you could always try for a partial payment if the insurance company are refusing outright. Also, unfortunately if your vets thought the insurance company was going to pay for the op, you probably won't have got the best price.